Cakdiometric apparatus



July 4, 1944- B. w. WILLIAMS l-:T AL

CARDIOMETRI C APPARATUS Filed July 14, 1941 3 Sheets-Sheet l OWN J m6 NON um I l l l ll |I)| l l l Il Zia/elijo?? Home?" 5. W'Zlzlam radlee Wk n www

July 4, 1944. B. w. WILLIAMS ETAL CARDIOMETRIC APPARATUS 1941 5 Sheets-Sheet 2 Filed July 14 July 4 1944- B. w. wlLLlAMs ET AL CARDIOMETRIC APPARATUS Filed July 14,

Patented July 4, 1944 CARDIOMETRIC APPARATUS Bradlee W. Williams and Homer S. Williams, Chicago, Ill., assignors to Tech Equipment Company, Chicago, lll.

Application July 14, 1941, serial 10,402,359

29 Claims.

This invention pertains to the measurement and detection of pressures and pulsations in fluid pressure systems, and more particularly in the arterio-circulatory system ot the human body.

A principal object of the invention is the provision of automatic apparatus, adapted to be coincontrolled, for automatically measuring the blood pressure and pulse rate.

Another objectis to provide means for ascertaining both the diastolic and systolic blood p ressure and manifesting the same independently.

A' further object is to provide means employing a single tourniquet capable of applying an occluding pressure to an artery, and also of coacting with pressure-sensitive switch means for controlling the occluding or applied pressure in a manner to actuate indicating means to express the systolic and diastolic blood pressures.`

A further object is the provision of mechanism controlled by the aforesaid pressure-sensitive switch means for actuating an indicator to manifest the number of true pulses occur-ing in a given testing period. p

Yet another object is the provision of automatic control means and circuit connections for effecting the pressure ascertaining and pulse-rate ascertaining operations in a certain order, automatically.

Still further objects are to provide a simple mechanism of the class described especially suited, by virtue of its structural and operating simplicity and organization, for automatic operation under control of a coin or token, so that it may be easily different manners, particularly from sub-diastolic levels upwards, in ascertaining systolic and diastolic arterial tensions; to increase the applied pressure and thereby detect and manifest arterial pressures at the diastolic level; to increase the applied pressure to a value suflicient to occlude blood new in said artery; to reduce the occluding pressure in timed and measured amounts; to test for a certain number and sequence of true pulses of one or both kinds in a timed interval to ascertain if there is a true resumption of blood flow as the pressure is reduced; to arrest such reduction when such ow is positively resumed and manifest the applied pressure then existing as a measure of the systolic blood pressure; to count the pulses by means responsive to pressure variations resulting from arterial pulses in the same tourniquet which is employed in applying the occluding pressure and to prevent counting of false variations in the nature of pulses resulting from various kinds of involuntary movements sensed by the tourniquet.

Additional objects are to provide pulse rate indicating means and timing means associated therewith utilized for control in both the pressure and pulse rateascertaining phases of the cycle of operation of the apparatus; to provide impositive drive means and justifying means for correlating certain movements of the pulse rate indicating means and said timing means and to provide simplified control means for a pulse counting mechanism.. r

Other novel aspects and features of the invention reside in various details of the integration, correlation, function, and structure of the parts and instrumentalities comprising the combination of the preferred embodiment of the device described hereinafter in view of the annexed drawings in which:

Fig. 1 is a pictorial schematic of the entire organization including various mechanical and electrical instrumentalities and connections therein;

Fig. 2 is a perspective detail of the arm rest and tourniquet;

Fig. 3 is a cross section along lines 3 3 of Fig 2:

Fig. 4 is a vertical section through the combination pulse rate indicating and timer unit;

Fig. 5 is a fragmentary exploded perspective of the pulse rate indicator and timer unit showing especially the clutch disc, the master cam switch. and star timer cam switch;

Fig. 6 is a front elevation of the detector switch;

Fig. 'I is a top View of the switch of Fig. 6;

Fig. 8 is an exploded assembly view of the working parts of the switch of Figs. 6 and 7.

Introductory statement of operation To use the apparatus, the patron inserts his wrist in a tourniquet device and tightens a strap holding the wrist rmly in place. Usually the patron is seated before the apparatus, and after placing the Wrist as aforesaid, he deposits a coin which starts the machine through its cycle of operation.

The tourniquet becomes inflated by air or other fluid pressure until pulses at the diastolic level are sensed by a detector device, whereupon testing mechanism automatically tests for a certain number of true pulses which, if detected. calmes a diastolic manometer or indicator to manifest the pressure at which the pulses were detected. This pressure corresponds to the arterial diastolic pressure.

Having ascertained the diastolic pressure, the machine automatically increases the pressure in the tourniquet to a high value to stop the blood iiow in the artery under test. Thereafter this elevated pressure is reduced step by step until pulses are again sensed by the detecting means, and test is again automatically made to ascertain ifthepulsesaretruearterialpulses; ifso,the pressure reduction stops automatically; if the requisite number and sequence of true pulses is not detected, the pressure reduction continues until such pulses are detected, whereupon the pressure then existing in the tourniquet is manifested by another indicator or manometer as the systolic blood pressure.

Having determined the diastolic and systolic pressures as aforesaid, the machine then automatically counts the number of true pulses in a certain period and manifests this count as the pulse rate, whereupon the machine shuts oil' preparatory to the next operation.

Means for ascertaining diastolic pressure InFig.2thereisshownanarm rest I including a trough portion ii and a complementary hand-form l2 to receive the hand when the wrist is disposed in the trough. Also xed in the trough is a wrist strap i3 with a tongue I4 which extends between jaw means, including a roller I5, seated in opposite flanges I6 cast with the rest, and a rocking jaw Il pivoted as at i8a in the flanges beneath the roller. A spring i8 normally urges the movable jaw in an anticlockwise direction to wedge the tongue against the roller. The movable jaw has a thumb-piece I9 circuit for which is completed via conductor Il leading through normally closed master cam switch contacts 4I and 41 to ground 48. 'I'he foregoing circuit thus momentarily established by operation of the coin switch causes relay B to pull up or become operated, and to close a holding circuit for itself through its contacts Il and il to grolmd 52. 'Ihis holding circuit will be broken only by opening of master cam switch contacts 4I and 4l at a certain stage in the operation of the machine.

As an immediate incident to the operation of relay B upon deposit of a coin as aforesaid, its

contacts 5I and 51 close to connect ground 5l' via conductor 5S to pump motor J2 and energize the same from its grounded battery 3B.

Also energized at this time from conductor 59 via conductor 60 from battery or power source il is the coil 62 of a normally open electro-magnetic escape, valve means 63, which closes against outlet i4 so that air pressure may be built up in the system, by pumps I0, particularly in reservoir 28 and main branch 21.

The air pressure built up as aforesaid starts from a sub-diastolic level or value and is exerted through bellows valve 26 upon branch 25 and by which it can be rocked clockwise to free the strap or tongue.

Secured in the bottom of the trough with the strap is in iniiatable cushion or bag 20 (Fig. 3) with a tube 2l passing through the bottom of the trough for connection with a iiuid pressure system presently to be described. A silk, or other suitable light-weight fabric, shield 22, flxed to the strap as at 23, protects and covers the cushion 20.

The foregoing rest including the strap and cushion constitutes a form of tourniquet adapted to be mounted on a suitable table portion (not illustrated) of the machine so that the subject or patron under testl may insert his wrist in the strap and rest, tighten the tongue I4, and by depositing a coin in the machine, for example, set the apparatus into operation. i

Referring to Fig. 1, it will be observed that the tourniquet cushion or bag 20 is connected through its tube 2l to a branch pressure conduit 25 which connects through a mm. bellows valve 2G to a main pressure conduit 2l leading into a fluid prsure receiver or reservoir 28 connecting through pipes 25 to a pair of tandem pumps 3l driven by a crank connection 3| from a pump motor 32.

When the patron deposits his coin in the coin receiver (not illustrated because conventional), a coin or starting switch 40 is momentarily closed connecting ground 4i to one terminal l2 of a relay B via conductor 43 and also via conductor 4I to one terminal of a relay A. The remaining terminal (2m of relay B connects to power 49a hence iniiates the tourniquet cushion 20 against the patrons wrist. As soon as the pressure reaches the relatively low value of about 45 millimeters of mercury, valve 26 closes by back pressure and closes safety switch contacts 65-88 by movement of bellows-moved arm or member 6l. Ii the patron removes his wrist from the tourniquet before completionof the the drop in pressure in bag 20 causes safety switch SS-SB to open for purposes later to appear.

The apparatus will now proceed to increase the pressure applied through tourniquet 2l in steps until diastolic pulsations are detected by a detector switch sensitive to pressure variations in branch 25.

This adjustment or variation upward of the pressure is effected through the agency of a pair oi' normally closed measuring valves H and I situated in branch 2l, and enclosing in their path a short section lll of measuring conduit which leads through valve I and a branch conduit 'H into the tourniquet branch 25, on the one hand, and through a conduit connection and a normally closed electro-magnetic manometer valve J into the well of a mercury manometer il designated as the Diastolic manometer, on the other.

A further conduit branch l5 leads from the main pressure line through valve I and a second normally closed electromagnetic manometer valve K into the well of a second mercury manometer 11 designated the Systolic manometer.

By alternately opening and closing the measuring valves H and I, it will be apparent that the pressure in the tourniquet branch can be gradually increased for the DUI'DOse of approaching the low or diastolic pressure which exists in each diastole of the cardiac cycle, and since the diastolic pressure phase is manifested as a pressure change or pulsation in the artery, a time will arrive when the increasing applied pressure is suiiiciently elevated to cause the tourniquet bag to yield and expand to the diastolic pressure variations, causing corresponding pressure variations in the bag itself and hence the pressure branch 25 to which it is connected.

Means for alternately opening and closing the measuring valves H and I includes a measuring switch which forms part of a combination pulse rate indicator means and timing unit including a timing motor 20 driving through slow clockwork gears a shaft 22 .upon which floats freely a pulse rate indicating dial 22. Motor 20 begins to run as soon as relay B pulls up upon deposit ofa coin, owing to connection of ground to themotor coil or winding 20a via conductor 24 connecting at 22 to a conductor 52 which is grounded by relay B. Power source 26 grounded at 21 drives motor 20 through the aforesaid connections until relay B nnally drops out.

Mounted to rotate constantly with timer shaft 22 is a star cam 20 engaged by the oiTset 0|a of a spring contact 2| of a timing switch including contacts 22 and 22 alternately engaged by contact 8| as the star cam rotates and to which central contact 0| therefore alternately connects ground 24.

The timing switch contacts 0|92 complete an operating circuit from ground 24 via conductor 25, normally closed contacts 20-21 on a relay A and conductor 02 to one side of the coil 22 for valve H, the other side of which coil completes circuit to battery 55 through conductor-- |02 and the first of two looped contacts |0| on a commutator switch bank #1, and thence through wiper |02 and conductor |02 with a conductor leading to battery 55 through contacts 52-54 on relay B. Thus, each time contacts 9|-92 open and close as the star cam rotates, the measuring valve H will open and close via the aforesaid operating circuit, to admit air to the measuring chamber or conduit 10.

Valve I is similarly operated in alternation with valve H by connection of ground 84 through contacts 9|-92, conductor |02 to junction |00 with conductor ||0 and thence via normally closed` contacts |||||2 on relay A to terminal ||2 on the coil ||4 of valve I. The remaining terminal of this valve coil connects to battery ||5 which completes its ground circuit via conductor ||2 and through normally closed contacts I|'|-||2 on a relay P to juncture H9 with a common ground wire |20 which finally connects at juncture 42a with ground wire 42 circuit to ground 52 for relay B.

Thus coil 4 for valve I is energized in alternation with coil 90 for valve H. and these valves open and close separately admitting a succession of small volumes of compressed air to tourniquet branch 25.

'Ihe pressure existing in the tourniquet system or branch 25 is indicated by the diastolic manometer 'i4 because its valve J has its coil 12 energized from ground 12a to the coil and thence through conductor 2|, normally closed contacts |22-|23 on relay A to juncture |24 with conductor |00, which, as heretofore described. leads to battery 55 (relay A) via contacts |0| and wiper |02 on bank #l of the commutator switch, the circuit thus described effecting an opening of valve J so long as wiper |02 remains on the tlrsttwo contacts |0| of bank #1.

As soon as the tourniquet pressure approaches the diastolic blood pressure, a sensitive pressureresponsive device or bellows |20 on the detector switch will move its plunger or rod |2| back and forth in correspondence to such pressure variations, and will carry with it a contact 22 in alternate engagement with systolic contact |22 and diastolic contact |24.

'I'he detector switch is shown in detail in Figs. 6 to 8, wherein one end 22a of the movable contact is freely rested in a bracket |25 on a base |24.

to juncture |04- on the holding" while the opposite end |22b oi' the contact |22 is disposed to move back and forth between contacts |22 and |24 under urgence by rod |2I, which passes freely through a hole |22c in contact strip |22 close to the end |22a, which latter end is fulcrumed on bracket |25 with suillcient freedom so that the strip |22 may rest by gravity on rod I2 to be carried back and forth by the latter responsive to pressure variations in bellows |20, which cause relatively slight back and forth movements of the rod.

When the toux'niquetv is first inflated. and when the pressure therein is subsequently increased in order to occlude blood flow, rod |2| is displaced outwardly (to the right in Figs. l and 8) a very appreciable distance which is much greater than the limiting distance between contacts |22 and |24; but owing to the impositiva or gravity driving connection between rod |3| and contact |22 by having contact |22 rest loosely thereon at hole |226. the rod |2| is free to project outwardly this relatively great amount, yet upon subsequent minute pulsatory movements of the rod |2| corresponding to arterial pulses, contact |22 will nevertheless be carried back and forth into and out of engagement with contacts |22 and 24. This arrangement permits one form of self-adjustment of the detector switch to various pressure conditions.

A further self-adjusting feature resides in having the systolic contact |33 also loosely mounted at one end by means of riveted thereto at |28 and provided with a hole |2`|a through which bellows rod |3| passes, the plate resting by gravity on the rod and being secured against dislodgment by a cotter pin |22 in rod |2I. I

'Ihe opposite (left-hand) end of contact |22 rests freely in a bracket |40, which limits the displacements of the contact |32 to a considerably lesser range than that of contact |32. Moreover, the situation of hole |21a remote from bracket |40, which constitutes a fulcrum for contact |22, makes the lever a long one with correspondingly slight displacements upon slight movements of bellows rod |2|.

As a result, the contact |22 tends to move not at all as a practical matter. compared with the movements of contact |32 in response to arterial pressure variations. Yet the bellows rod is free to move abruptly info various positions of adjustment at all times. Moreover, the greater the displacements of the bellows rod |2| responsive to arterial pulses, the greater will be the relative displacement of contact |23 with respect to contact |22, but since the ratio of relative displacement of both contacts |22-|33 is constant. and is greater or less with respect to the stationary contact |24, depending upon whether or not the pulses are strong or weak, the amplitude of contact displacement is self-adjusting for both weak and strong pulses. This is very important because the actual contact displacement responsive to arterial pulses is only a matter of two or three thousandths of an inch on the average. Contact |24 is adjustable.

A further feature of the detector switch is the provision on base |26 of an insulating plate |27A switch to conductor |56 which lows, high-pressure against contact |44.

A stop spring strip |45 has an angled end |45a also disposed to be engaged by plate |31 to limit the outward movement of the contact |33. Contact strips I 43, |44 and stop strip |45 are all mounted at one (left) end between insulating wafers |46 on base |36 in the manner of the usual switch stack assembly.

Pulse verifying means Referring again to Fig. l. it will be seen that detector or. bellows switch contact |32 is grounded at |48. Each time contact |33, circuit is completed via conductor |48 to termii'ial I|50 of a sensitive systolic relay S, whose other terminal is connected in common with another sensitive diastolic" relay D to one side of a power source or battery |5I,V from which circuit to ground is completed via normally closed contacts |52|53 of a lcam reset switch. Contact |52 connects via conductor |55 and contacts 65 and 66 on the low pressure or 45 mm. bellows connects at |51 joining at 43a to Thus, systolic relay immediately locks its switch contact |43 is closed and |58 to a ground wire |20 ground 52 set up by relay B. S pulls up, andv moreover own holding circuit via its ground |62. .I

When systolic relay S pulls up as aforesaid it sets up an operating circuit for the diastolic relay D via contacts |63|64 and conductor |65 to detector contact |34 and one terminal of coil |66 of the sensitive diastolic relay D, the other terminal of which connects with battery |5| for energization through the normally closed reset cam switch ground circuit |52|5352 heretofore described; therefore. as soon as a decreasingpressure pulse in the toumiquet causes detector switch contact |32 to move back and connect ground to contact |34, circuit is completed to energize diastolic relay D, which locks its own holding circuit through its contacts 61| 68 to ground |62 via systolic contacts |60-|6|.

As an incident to the aforesaid energization of diastolic relay D, ground |62 is connected through contacts |68|10 to power or battery |1| for which circuit is coil 35 of the reset cam switch to ground wire |20 at |58, so that coll 35 is energized and withdraws a cam holding pawl 35a from cam 34, which cam has a frictional or other suitable slip-clutch driving connection with Ithe constantly rotating shaft 33 on the pump motor. Such a clutch is not seen in the illustration but after in view of Figs. 4

As soon as holding aforesaid, cam 34 is free to rotate and present one and 5.

thereof in position so that an offset |52a on spring |52, which rides on the rim of cam 34 as shownin Fig. 1, may press into the notch, thus separating contacts |52|53 and breaking the common power connection from battery |5| for both the systolic and diastolic relays. which therefore become deenerglzed and released.

Such movement of cam switch contact |52 also causes it to close circuit with a contact |54 via conductor |14 to connection |15 with a wiping contact |16 on bank #2 of the commutator switch for` testing purposes, this circuit. connecting ground through Wiper |16 and the first contact |11 on bank #2, via conductor |8| to one terminal of a step-up coil |82 connected to grounded batt-'y |83 and thereby energized to actuate a step- |82 engages contact.

completed through the release" will be explained herein-V assasvs.

ping pawl |84 and cause a stepping ratchet |85 to step once, whereby commutator switch shaft |88 is rotatively stepped to move all wipers to second position (clockwise in Fig. l)

A return spring |81 normally tends to restore shaft |86 with its wipers to first position, but such restoration is prevented by a releasable holding pawl |88 adapted to be released by`a reset 'coil |89.

It will thus appear that the sensing or detecting of the first complete diastolic and systolic pulsation at the diastolic pressure level by the tourniquet and associated detector switch, will cause the commutator switch to step to second position; and this action constitutes part of a testing operation, which `for completion, requires a plurality of such pulses in a certain order and timed interval.

Reset cam 34 may make only a. half revolution before it isagain stoppe'd by its pawl 35a, with the result that a power circuit is again set up by contact |52|53 for further operation of the sensitive systolic and diastolic relays by the detector switch. i

The next complete arterial pulsation to actuate the detector switch as aforesaid, will cause the commutator switch to make another step. carrying wiper |16 to third position on a dead contact in bank #2; moreover, wiper |02 in bank #l leaves the second contact |0| and lodges upon a dead contact at third position, thus breaking the circuit to conductor |05 for the respective solenoids of measuring valve H and manometer valve J, so that the latter will hold its pressure reading for the time being, pending further testing operations.

Meanwhile, the star cam 80 is rotating at a rate which will provide an interval sumciently long for at least two pulses to occur between successive operations by the star cam of timing switch contacts 8 |-82-83.

After the commutator switch wipers are disposed in third position by the first two detected pulses, control of the step-up coil |82 shifts from the sensitive relays S and D to the timing switch via conductor |8| from thel step-up coil, third contact |85 and wiper |86, bank #3, conductor |08 and contacts 8|-83 on the timing switch to ground 84. Hence, while the commutator switch rests at third position, a third step will be taken thereby in the time during which at least one more or the third pulsation would normally occur (time being afforded preferably for two pulses), and during which time the closure of timing switch contacts 92-83 causes step-up coil |82 to be energized to carry the wiper contacts to fourth position.

position of the commutator bank #3, is on contact |83 which is looped to conductor leading to the reset coil |88, thus connecting the latter for energization from battery |81 (grounded through normal contacts |88| 88 on relay P to ground 200) .should the timing'switch be able to close its contacts 9|-83 before the commutator switch can make another step to break the aforesaid resetting circuit.

If no further arterial pulse is detected during the testing interval in which the commutator switch rests in fourth position, reset coil |89 will be energized by the timing switch to withdraw the holding pawl |88 and permit spring |81 to rotate commutator switch shaft- |86 to initial or first position, whereuponv operation of -measuring valves H and I will be resumed, and the test for a series of pulses will be repeated until the commutator takes ve steps under alternate control of the sensitive relays S and D and the timing switch.

Assuming that the commutator switch has taken three steps so as to lodge wiper |19 on fourth contact |19, bank #2, the next complete pulse would cause reset cam switch contacts |52-I54 to close and actuate the step-up coil, which would advance wiper |16 to contact |00; then another complete pulse would cause the commutator switch to advance the Wipers again, lodging wiper |02 on the last contact 20|, bank #1, connecting battery 55 via conductor 202 and normal contacts 203-204 on relay A to energize the coil of the latter, and the test for systolic pressure goes forward.

Means for ascertaining systolic pressure Energlzatlon of relay A cuts oI the coil of valve I from the timing switch by breaking contacts |||||2, but connects this coil, ||4, via make contacts ||2205, conductor 205 through normal contacts 201-208 on relay C, to ground 209, causing valve I to remain open.

Likewise, the coil of valve H has its intermittent operating circuit from the timing switch broken at contacts 96--91 of relay A; but contact 91 now makes with contact 2|0, which provides an operating ground 2|3 through normal contacts 2||2|2 on said relay C, assoon as the commutator switch is reset, as it is presently by operation of the timer switch.

Thus, movement of the commutator switch into sixth and last position stops the intermittent operation of measuring valve H and I and causes both valves to remain open, admitting full pressure from branch into the systolic branch 15, upon return, as aforesaid, of the commutator switch to irst position.

As another incident to the energization of relay A, the latter makes its own holding circuit through make-before-break contacts 204-220 leading directly to battery 55 instead of through last contact on bank #1, by means of which relay A is initially energized through contacts 203-204, until the latter are separated by action of contact 220 in making with contact 204.

It may be observed here that relay C is operated in conjunction with the test for systolic pressure, and is principally instrumental in changingconnections to the commutator switch for the later operation of relay P. Relay P is operated in conjunction with the test for the pulse rate, following completion of the systolic pressure test.

Still another incident to energization of relay A is the energization of the coil 16 of systolic manometer valve K from grounded battery 15a via conductor 22|, and contacts |23, 222 of relay A to juncture with |24, thence via contacts |0|, |02 on bank #1, conductor |03, junction |04 and conductor |05 through 50, 5| to battery 55, thus exposing the mercury column in systolic manometer 11 to the air pressure in branch 15, which pressure now rises to its maximum predetermined value of approximately 200 mm. Hg, and is suillcient to occlude the blood now in the artery leading past the portion of the wrist held in the tourniquet, for in the majority of persons the arterial tension does not exceed this value. Higher occluding pressures could be easily provided, but would prolong the testing period merely for the sake of reading occasional pressures above 200 mm.

The rise in pressure in the system is immediately communicated to the tourniquet branch via connection 1|, and has the effect of expanding the detector bellows |30, the detector switch readjusting itself in the manner hereinbefore described, and causing bellows rod |3| to carry plate |31 against high-pressure contact |43 to close the lsaine against contact |44 as the pressure reaches its maximum occluding value.

This close of high-pressure switch contacts |43, |44 connects the common ground conductor |20 (which is connected via |58-43 to ground 52 through contacts 50-5I while relay B is energized) to conductor 224 and thence to one terminal of the coil of relay C, whose other terminal connects with battery 2|4 grounded at 2I3, so that relay C is energized and locks its own holding circuit via its contacts 2|5-2I6 to the ground 209.

Energization of relay C causes closure of both measuring valves H and I by breaking the respective holding circuits of their corresponding operating solenoids at contacts 2| |-2|2 and 201-208 on relay C, but valve I at once begins to open again intermittently because its coil ||4 is energized via conductor ||6a from battery ||5 through contacts ||2205 on relay A, conductor 205, contacts 201-255 on relay C to junction |00, thence via conductor |08 through timer switch contacts 9|-93 to ground 94; so that intermittent closure of the timer contacts 9I-93 by the star cam causes similarly timed opening and closing 0f valve I.

In order to decrease the applied or occluding pressure step by step, a bleeder or escape valve L in main pressure branch 10 has a valve means 230 normally closed, but adapted to be opened by the coil L, which has one terminal connected via conductor ||6a to battery ||5, and its other terminal connected via conductor 23| and contacts 232-233 on relay C to conductor which connects through intermittent closings of timing switch contacts 9|-92 to ground to energize coil L and open the bleeder valve in alternation with valve I. Thus, the pressure in the tourniquet is dropped by admitting to the conduit section 10 its capacity of air through valve I, closing valve I and opening the bleeder valve, and so on, until the blood flow is resumed in the artery under test, and systolic and diastolic pulsations again actuate the detector bellows |30 and associated detector switch parts to cause energization of the systolic sensitive relay S, and then the diastolic sensitive relay D, in the manner heretofore described in explaining the operation of these relays in testing for pulses at the diastolic level.

In order to test for true pulses, as in the case of ascertaining the diastolic blood pressure, the commutator switch is restored to starting or first position by contacts 201-225 on relay C as a result of the energization of relay A and the described connection of ground 94 through timer switch contacts 9|-93, conductor |08, wiper |96 to last contact |9| on bank #3 to reset coil |89, which is thus energized from battery or power source |91 to Withdraw holding pawl |38 so that spring |81 can rotate the switch shaft and restore the wipers to the iirst position.

The ilrst two successive and complete pulses (i. e. systolic pulsation followed by the attendant diastolic pulsation) cause the commutator switch to step twice under control of the reset cam switch contacts |52| 53, as heretofore described, thus carrying wiper |96 to contact |95, bank #3,

the ground 209.

and shifting step-up control to the timing switch via conductor |08 for the next step. which again restores step-up control to the reset cam switch and the sensitive relays for succeeding advances occasioned lby a succession of true pulses.

The commutator switch will reset, if the requisite number of pulses is not registered in the time provided; but upon advance of the commutator switch to nal testing position to lodge wiper |02 on the last contact 20| of bank #1, a relay P is energized to initiate the pulse rate test, this being eiected by connection of power from battery 55 via wiper |02 and conductor 202 to the coil of relay P and thence from the coil via conductor 240 and contacts 24|-242 on relay C to Systolic manometer valve K closes as soon as wiper |02 leaves second position, bank #1.

Pulse count meansv As a result of energization of relay P, the

ground circuit from juncture I9 via normal conn tacts ||1| |8, conductor ||8 to battery H5, for valves I and L, is broken; so that there will be no further change in pressure in the closed system, which includes the tourniquet, until the machine shuts oil.

However, arterial pulses will continue to actuate the detector switch and sensitive relays S and D with consequent actuations of the reset cam switch means 34--35-35a and contacts |52- |53|54 upon each complete pulsation.

Relay P sets up a-circuit through reset cam switch contact |52,-|54 via conductor |14 through contacts 245-245 on relay P and thence via conductor 241 to a clutch release coil 248,

Vwhich is thereby energized from battery 249 connected to common ground wire |20, in consequence of which a clutch disc holding pawl 250 ,is withdrawn from holding engagement in the teeth of a clutch disc mounted on timer shaft 82 and driven thereby through a slip clutch mechanism now described in the views of Figs. 4 and 5. Dial 83 is secured to the clutch disc by spacing posts 21|. Interposed between the dial and the disc on shaft 82 is a spring 212 which bears against a cotter pin 82a in shaft 82 at one end (Fig. 4), and against a metal washer 213 and a felt washer 214 on the other end, which washers are thereby urged against the clutch disc. Both the dial and disc are free or floating on shaft 82. Interposed between the opposite face of the clutch disc and master cam 252 is another set 2151: (Fig. 4) of alternatev metal and felt washers 215-215a-215b respectively (Fig. 5), while still a third set 2151: (Fig. 4) of felt and metal washers 21B- 21Go respectively (Fig. 5) is interposed between the master cam and the star cam 90, which is fast on the shaft 82 by means of its set screw 90a. Y

The operative assembly of the foregoing parts is shown inFig. 4, while their functional or relative disposition is shown in Fig. 5. Thus, spring 212 urges the assembly ofdiscs and washers against the constantly rotating star cam for rotation therewith through the frictiona1 resistance of the washers, but if the clutch disc 25| or master cam 252 are restrained sufficiently to overcome the frictional drive aiorded by the spring and washer slip-clutch arrangement, the shaft 82 and star cam may nevertheless continue to rotate. Therefore, while pulse rate dial 83 and clutch disc 25| are ixed for Joint rotation, the fact that clutch disc 25| is impositively driven from shaft 82 through said slip-clutch, makes it possible for pawl 250 normally to restrain rotation of the disc and dial although shaft 82 is driven constantly while the machine is in use. The master 252, driven impositively with clutch disc 25|, may be restrained by the brake pawl 253 normally riding on the rim of the master cam and engaged by the shoulder 254 of a shallow notch or relieved portion 255 on the cam.

Thus, clutch disc 25| may rotate, while master cam 252 may be restrained or vice versa, but if the clutch disc is permitted to rotate long enough, (as when the machine is irst started upon a cycle oi operation) a pin 256 thereon will transiently engage a spring contact 251 and Spring it out of normally closed-circuit engagement with a companion contact 258, thereby opening a circuit from ground 259 via conductor 250 through normal contacts 262--245 on relay P, thence via conductor 241 to the clutch coil 248, so that such opening of the ground 259 prevents energizing the clutch release coil 248.

When the machine is first set into operation by a coin, clutch releasecoil 248 is energized from power 249 and normal contacts 24S-252 on relay P, and the normally closed dial-locating contacts 251-258, because relay B provides ground for battery 249.

As the clutch disc rotates from whatever position it happens to have been left in during a previous operation of the machine. an index or pointer 264 on the dial 83 moves approximately into zero or starting position relative to a zero or other starting point 285 just as pin 255 opens locating switch contacts 251-258, therebyV to deenergize clutch coil 248 so that pawl 250 stops the clutch disc, and hence the pulse rate dial, at or closely near zero position. This occurs at the start of the cycle of operation.

When relay P pulls up for the pulse counting operation, the rst few closures of reset cam switch contacts |52|54, responsive to detected pulses, causes energlzation of the vclutch release coil 248 via conductor |14 through contacts 245--246 on relay P, conductor 241 to coil 248.

At the moment the foregoing operating circuit for clutch coil 248 is supplied by relay P as aforesaid, a pin 210 on the clutch disc transiently engages and rocks brake pawl 253 to free the master cam. 252 for rotation in step with the dial 83 from zero position.

Each complete pulse detected (consisting of a systolic and attendant diastolic impulse) will cause energization of the clutch coil 248 via closed contacts |52-l54, conductor |14, contacts '24e-24s of remy P, and wire zu, con m. power 249 to common ground wire |20, connections |58, |51, wire |56, switch Sii- 65, wire |55 to reset contacts |52, |54, as aforesaid, for the time required by reset cam 34 to close and open the circuits through contacts |53-|54, the rotation of the reset cam by motor 32 being held within limits, and uponeach release of clutch disc holding pawl 250, the disc and dial may move a substantial amount by timed rotation of drive shaft 82,

the stop, which has a hole 233 fitting loosely on shaft 82.

It will be recalled that this master cam is freed to move the instant the dial index is brought into starting or zero position. In the predetermined testing time, twenty seconds, the stop projection 230 is brought around beneath, and transiently engages the offset portion 46a of contact 43 and separates the latter from normally closed circuit engagement with contact 41, thereby breaking the power circuit from battery 43a, ground 49, for relay B. Contacts 46-41 immediately close again, since the stop projection is carried there-beyond into its starting position 'as shown in Figs. 1 and 5, where it is held by action of brake pawl 253 in arresting the master cam.

Release o1' relay B as aforesaid breaks the main ground connections 50-5I-52 and 56-51-58 stopping all motors and releasing all other held relays, which results in a shutting off of the machine, an incident of which is the opening of escape valve 63-64 to relieve pressure in the tourniquet.

The readings on the pulse rate dial and both manometers remain until the next operation of the machine.

Summary of operation The patron places his wrist beneath the tourniquet strap I3 in rest I0 with the hand cupped on form I2, then pulls tongue I4 taut, jaw means I1 holding the tongue against loosening. A coin, preferably, is used to close starting switch 40, whereupon escape valve 63-64 closes, and the pump and timer motors 32 and 80 start.

The pumps 30 build up air pressure which inflates the tournlquet bulb or cushion 20 against the patrons wrist, but as soon as a certain minimum sub-diastolic pressure, say equal to 45 millimeters of mercury, is reached, bellows valve 26 shuts off the tourniquet from the reservoir and closes safety switch 65-66 to connect the cam reset switch for service.

When the start or coin-switch is operated, relay B pulls up and holds; also, the clutch release coil 248 is energized through normal contacts 24h-262 on relay P, so that the dial is free to rotate toward zero position 265, in which position pin 256 on the clutch disc opens locating switch 251-258 to break the aforesaid circuit to the clutch release coil and stop the dial and disc approximately at zero position 265.

Meanwhile, measuring valves H and I open and close alternately under control of timer switch contacts 9|-92-93 through normal contacts 96-91 and I2 on relay A, thus gradually and intermittently increasing the pressure in the tourniquet through branch 1|.

Ultimately, sufiicient artificial pressure will be thus applied by the tourniquet to the artery under test to equal the diastolic arterial pressure, in consequent ci which the arterial pulses accompanying each systcle and diastole of the cardiac cycle, will increase and decrease the pressure in the tourniquet in correspondence to the same `pressure variations in the artery, and therefore the detector switch bellows |30 through rod |3| will move detector switch contact |32 back and forth to alternately engage the systolic contact S or |33 or the diastolic contact D or |34, thus first energizing the systolic relay S, which locks a holding circuit for itself at contacts |60|6|.

The systolic relay also sets up an operating circuit from the detector switch at contacts |63-|64. A diastolic 'pulse following the aforesaid systolic pulse will energize the diastolic relay D via conductor |65 and contacts |53-I64 on relay S, and the diastolic relay will also lock its own circuit at contacts |61-I68, and, in addition, will energize the release coil 35 for the cam reset switch via contacts IBS-|10 battery |1I, conductor |12.

Energization of the reset release coil withdraws holding pawl 35a so that cam 34 is free to be rotated by shaft 33, to which the cam is drivingly conected through a slip-clutch drive not seen but identical in principle to the washer arrangement 215-215a-215b in Fig. 5 herein, a spring washer being substituted for spring 212.

Rotation of the reset cam opens contacts |52- |53 on the reset switch, breaking the circuit to power source |5I for both the systolic and diastolic relays S and D and thereby resetting the same.

Rotation of the reset cam by detection of a complete pulse as aforesaid, also actuates a testing means by closing cam reset contacts |52-I54 to energize the step-up coil |82 of the commutator switch via conductor |14, wiper |16 and first contact |11 on bank #2, causing advancing pawl I 84 to step ratchet |85 once and rotate shaft |86 to dispose all wipers at second position.

A second complete pulse would cause a repetition of the foregoing process, except that the step-up coil would be energized through secondposition contact |18, bank #2, and control of the step-up coil would be transferred to the timing switch contacts 9|-93 via conductor |08 to wiper |96 on bank #3.

In the meantime, :nanometer valve J has remained open as the pressure rises to the diastolic level (through normal contacts I22|23, relay A).

Following the rst two detached and complete pulses, is a lapsed-time interval during which at least one, and preferably two complete systolic and attendant diastolic pulses may occur,

as determined by the regulated speed 0f rotation of the star cam 90, which is arranged to cause two closures of contacts 9|-93 in this interval to step the commutator once via wiper |96 at third position, or contact |95. The commutator switch now rests at fourth position, and control thereof reverts to the sensitive relays S and D and reset cam switch.

If now two additional and complete pulses are detected to actuate relays S and Dthe commutator switch will step to sixth position and relay A will be energized via wiper |02 and last contact 20|, on bank #l through normal contacts 203- 204 on relay A.

After the first two successive Ipulses are detected, diastolic manometer valve J is closed and measuring valves H and I are temporarily disabled because wiper |02 on bank #l leaves contacts |0I, disconecting power from conductor |00.

If, however, no further pulses are detected (e. g. either the fourth or fifth actual and complete pulses) following the lapsed-time interval, the commutator switch will be reset via wiper |96 and either of the last two contacts I9! or |93 on bank #3, energizing reset coil |82 from conductor |08 and timer switch contacts 9| 93, whereupon a further pressure increase would occur by the next alternate operation of measuring valves H and I, and the aforesaid testing process would be repeated until the commutator switch moves to The test for the systolic pressure goes forward as soon as relay A pulls up, for thenthe coils controlling valves H and I. hold said valves open via contacts 31-2I0 and ||2-205, respectively, on relay A. thus allowing the pressure to rise to a maximum in the toumiquet.

Meanwhile, valve J of the diastolic manometer will have finally closed to hold its reading, owing to interruption of the operation circuit for its coil 13 at contacts |22|23 on relay A. But valve K for the systolic manometer opens when relay A pulls up by closure of contacts |23 and 222 on relay A.

As the pressure rises in the tournique't to the occluding value, high pressure switch contacts |43|44 are closed by the detector bellows, and the sensitive detector switch readjusts itself. Closure of the high-pressure contacts energizes relay C via conductors |-2H.

Energization of relay C breaks the hold-open circuit for the solenoid of valve H. at contacts 2| |-2|2 on relay C.

Relay C also resets commutator switch by energizing reset coil |183 via last contact |3|, bank #3, wiper |95, juncture |09 through contacts 201-225 on relay C, and contacts 3|-33 upon closure by the star cam, whereby to dispose the switch in readiness to test for pulses at the systolic level.

The occluding rpressure will now be dropped step by step by opening and closing of valve I via contacts ||2205 on relay A, conductor 208. contacts 201-225 on relay C, conductor |08 to time the master cam will have rotated to move its stop projection 200 around beneath contact 46a to separate it momentarily from contact 41, thereby breaking the power circuit to ground 45 for relay B, which thereupon releases, and all circuits are restored to normal pending repeated operation of the machine.

It is to be understood that the designation herein of the power source by use of the conventional electrical symbol for a battery, and the conventional ground symbol to indicate a common conductor, is not intended as a limitation, but is used merely for convenience to provide a minimum number of conductors for purposes of simplification. Any suitable power source and mo'de of-connection thereof may be used.

The foregoing description and illustrations are submitted as merely exemplarly of one preferred arrangement and form of the invention, and

various circuits is intended, except insofar as the timing switch contacts 3|-93, in alternation y with bleeder valve L via conductor 23|, contacts 232-233 on relay C and conductor 95 to timing contacts 9|-92.

Reduction of the occluding pressure will continue until a succession of true systolic and diastolic pulses causes the commutator switch to be (if not successive the timer switch will reset the i commutator in the interim), which are followed by a measured lapsed-time interval suilicient for a predetermined number of pulses to occur, the m arrangement shown permitting by preference two such complete pulsations, whereupon there must follow` twoymore complete pulses to step the commutator to last position. kwith the result that manometer valve K will remain closed and pulse rate-relay P will be energized via wiper |02 and last contact 20| on bank #1.

The rst pulses to be counted cause energization of clutch coil 248 via (reset cam contacts |52-|54, conductor |14 through contacts 245- 243, on relay P, conductor 241 to the coil, battery 249, ground wire |20, connections |58, |51, wire |55, switch contacts 66, 65, wire |55, reset contants |52, |54, as aforesaid which frees the disc and dial for intermittent steps corresponding to the pulses.

Just as dial index 264 approaches zero position 265, pin 210 raises brake pawl 253 to free the master cam, which therefore starts in step with the dial.

Pulses continue to cause energization of the clutch release coil (via |52|54|14245 246-241) the coil 248, battery 249 to common ground wire |20 until the predetermined testing period of twenty seconds has elapsed, at which 75,

' appended claims may be specic thereto, it being understood further that modifications in such connections and in the form and mode of operation of the instrumentalities named, may be made without departing from the scope of the invention, and no limitations are intended except as specifically contemplated by the following claims.

We claim:

l. Apparatus of the class described comprising, in cooperative combination, means for applying a pressure upon an artery, means for increasing said pressure from a sub-diastolic to the diastolic level of an artery under test, means coacting with said applying means for' detecting arterial pulses in saidartery, means controlled by said detecting means to arrest pressure increase as aforesaid by detection of a certain number of pulses, means for manifesting the applied pressure following arrest as aforesaid, as a measure of the diastolic pressure, means for thereupon automatically increasing said pressure to an occluding level, means for reducingl said pressure automatically from occluding level in measured decrements until a certain number of pulses are detected by the detecting means, and means for manifesting the applied pressure, upon cessation of reduction as aforesaid, as a measure of the systolic pressure, and means for coordinating operation of the aforesaid means whereby to vprocure automatic operation thereof for the purposes and in the order named.

2. Apparatus as defined in claim l, further characterized by the provision of means controlled by said detecting means for counting the number of arterial pulses in a given period following manifestation of the systolic pressure as aforesaid, and means for setting said pulse countcreasing said pressure from a sub-diastolic to a diastolic value in an artery under test, detecting means responsive to pressure variations in said applicator, occasioned by arterial pulses at the diastolic level, means for arresting pressure increase as aforesaid when a certain number of said pressure variations have occurred; means for manifesting the pressure in said applicator as a measure of the diastolic pressure following arrest as aforesaid. means for thereafter increasing pressure in said applicator to an oocluding value, means for reducing said -pressure from said occluding value step-by-step until a certain number of pulses are detected at a point close to the pressure of occlusion, and means for manitesting the pressure in said applicator at a time following detection of said last-mentioned number of pulses.

4. Apparatus of the class described comprising the following combination of cooperating instrumentalities: a tourniquet applicable at the wrist and inflatable by fluid pressure, means for infiating said tourniquet to a pressure where diastolic arterial pulses are manifested by corresponding pressure variations in the tourniquet, means operated by occurrence of a certain number of said variations in the tourniquet pressure, for temporarily preventing change of the tourniquet pressure by the inating means, means for manifesting the pressure in the tourniquet, at

or following the last of said number of variations, as a measure of the diastolic pressure, means for maintaining the reading of said manifesting means during a subsequent period, means for increasing the pressure in the tourniquet until no effective variations due to `arterial pulses are manifested in said tourniquet, means for reducing said pressure until effective variations are again manifested by variations in the tourniquet pressure, and means actuated following occurrence of another predetermined number of said last-mentioned variations for preventing further reduction in the tourniquet pressure, together with means for manifesting the pressure inthe tourniquet as a measure of the systolic pressure following operation of the preventing means as last-mentioned.

5. In an apparatus as defined in claim 4, the further provision of means registering said pressure variations in the turniquet at the level of diastolic pressure, and means for manifesting registered variations as pulses in terms of a rate per unit of time.

6. In a device of the class described including means for applying a testing pressure to an artery, and means controlled by said applying means for detecting arterial pulses, apparatus and means actuating the same automatically in testing cycles for ascertaining both diastolic and systolic arterial tension, said apparatus including means for adjusting said applied pressure upwards to the diastolic level to condition said detecting means for detection of diastolic pulses, means for manifesting the degree of applied pressure at a time when diastolic pulses are detected as aforesaid, means for thereafter elevating the applied pressure until blood flow is stopped, means for thereafter reducing said elevated pressure by uniform decrements until blood flow can be resumed, and means for determining said resumption and cooperable with said detecting means to prevent further pressure reduction if a group of pulses are detected, together with means for manifesting the degree of applied pressure as the systolic pressure at the time of, or closely following, resumption of blood flow as aforesaid.

7. An apparatus for ascertaining diastolic and systolic blood pressure including: a single wrist strap and an infiatable bag conformed to be held thereby against the volar aspect of the wrist, to apply pressure upon an artery, means for inating said bag by increments at timed intervals until diastolic arterial pulses eect reactionary pressure variations in said bag. means for exhibiting the degree of pressure in said bag during increments as aforesaid, means conditioned for operation by a group of said reactionary variations for preventing change in the vexhibited degree of pressure, means for automeasure of the systolic pressure at least as of v the time a group of said variations occurs following resumption of iiow as aforesaid.

8. In apparatus of the class described, in combination, a pneumatic tourniquet for application of pressure to an artery, a, pair of manometers, means connecting said manometers in a pressure system including said tourniquet, pressuresensitive detecting means communicating with said system, means for increasing air pressure in said system by measured amounts toward an expected diastolic level at which diastolic arterial pulses will effect pressure variations in said system, means for closing of! each of said manometers from said system, means controlled by said detecting means responsive to detection of a group of test pressure variations in the system at the diastolic level for actuating the closing-ofi' means for one of said manometers thereby to indicate the diastolic pressure, means controlled by saidv detecting means following detection of said test group of pulsations for directly raising the applied tourniquet pressure to a degree above a certain expected average systolic level, means for thereupon effecting reductions in the raised pressure at uniformly spaced intervals, and means actuated under control of said detecting means following detection thereby of another group of test pulsations for closing oil' the other manometer whereby to hold its reading as a measure of the systolic pressure.

9. Apparatus, as dened in claim 8, further characterized by the provision oi totalizing means for counting pulses, means controlled by said detecting means operable following detection of one of said groups of test pulses for effecting an advance of said totalizing means for each detected pulse, and means conditioning said totalizing means for operation for a determined period, whereby the total of pulses will be representative of the pulse rate.

10. Apparatus of the class described comprising, in combination, means for detecting arterial pulses in an artery under test, means for applying testing pressure to said artery, means for increasing said pressure from a sub-diastolic level, automatically in steps, until pulses are detected by said detecting means, means operable under control of said detecting means responsive to detection of a certain number of pulses to exhibit the degree of pressure applied as of the time of detection of the last of said number of pulses. means thereafter operable automaticallv to increase said pressure to an occluding value. means for reducing said pressure automatically until pulses are first again detected by said detecting means, and means for counting a certain number of said last-mentioned pulses and exhibiting the pressure existing as of the time of the counting of the last of said pulses.

11. Apparatus of the class described comprising, in combination, means for detecting'arterial pulses in an artery under test, means for applying testing pressure to said artery, means for increasing said pressure from a sub-diastolic level, automatically in steps, until pulses are detected by said detecting means, means operable under control of said detecting means responsive to detection of a certain number of pulses to exhibit the degree of pressure applied as of the time of detection of the last of said number ofpulses, means thereafter operable automatically to increase said pressure to an occluding value, means for reducing said pressure automatically until pulses are nrst again detected by said detecting means, means for counting a certain number of said last-mentioned pulses and exhibiting the pressure existing as of the time of the counting of the last of said pulses, and means under control of said detecting means and operable automatically following counting of said last-mentioned pulses for counting additional pulses occurring in a given period of time and exhibiting the said number of additional pulses in terms of a rate of pulses per unit of time.

12. In a blood pressure machine, means for applying a testing pressure to an artery, means for detecting pulses in said artery, means operable automatically in testing cycles for rst raising the testing pressure to the diastolic level, counting a certain series of pulses, exhibiting the value of the pressure level at which said pulses were counted, thereafter increasing said pressure automatically to a value above a systolic level in said artery, reducing said pressure until further pulses are first detected, counting a second series of said pulses, then exhibiting the value oi' the applied pressure level at which said second series of pulses was counted.

13. In a blood pressure machine, means for applying a testing pressure to an artery, means for detecting pulses in said artery, means operable automatically in testing cycles for first raising the testing pressure to the diastolic level,

Acounting a certain series of pulses, exhibiting the value of the pressure level at which said pulses were counted, thereafter increasing said pressure automatically to a. value above a systolic level in said artery, reducing said pressure until further pulses are rst detected, counting a second series of said pulses, then exhibiting the value of the applied pressure level at which said second series of pulses was counted, and means operable automatically thereafter for counting a third series of pulses during a time interval and exhibiting the value oi said counting operation.

14. In a blood pressure machine, in combination, means for applying iiuid pressure to an artery, separate diastolic and systolic pressure gauges, means for .automatically adjusting the applied pressure upwardly or downwardly in steps of predetermined volume, means for increasing the applied pressure to an occluding value in one step, electrical timing "and control means arranged and constructed to correlate the operation of the foregoing instrumentalities to increase the pressure in a plurality of steps to the diastolic level and thereafter increase the pressure in one step to an occluding value above the systolic level, and thereafter reduce the pressure in steps to the systolic value, and to cause said pressures to be exhibited respectively on said diastolic and systolic gauges.

15. In a blood pressure machine, means for applying uid pressure to an artery under test, and for increasing said pressure from sub-diastolic levels to above a systolic level by timed and volumetrically predetermined increments, means for reducing said pressure by timed and volumetrically predetermined decrements, separate diastolic and systolic gauges, step-operating pulse counting means, timing means, and control means coordinating the operation of the aforesaid instrumentalities to increase the pressure to the diastolic level of an artery under test, then to an occluding level above systolic, then decrease said pressure to the systolic level, to manifest the value of diastolic and systolic pressures aforesaid, to verify pulses at both levels, by counting and timing pulses in said artery at both diastolic and systolic levels, and to count the number of true pulses, each consisting of a systolic and attendant diastolic pulse, occurring in a timed interval, and to exhibit said count.

16. In a blood pressure machine the combination with means for detecting diastolic and systolic pulse effects, of control mechanism including a relay controlled by diastolic pulses and a relay controlled by systolic pulses, connections for setting up a locking circuit for each said relay upon actuation thereof, a cam reset switch actuated by one of said relays for breaking said locking circuit for both relays following successive actuation thereof, and blood pressure ascertaining means operably controlled by a certain number of operations of said cam reset switch.

1'1. In a blood pressure machine of the type including a pulse detector switch actuated by diastolic and systolic pulse effects, control means comprising: a diastolic relay and a systolic relay connected to be actuated by Asaid switch, one of said relays setting up an operating circuit for the other, and connections established by both relays for locking the respective operating circuits thereof following each actuation by said detector switch, together with rotary cam reset switch means operably controlled by one of said relays for breaking said locking circuits, and means actuated by a predetermined number of operations of said reset switch means to effectuate certain operations of said machine.

18. In apparatus of the class described including mechanism for ascertaining cardiometric data, control means comprising: detector switch means actuated by diastolic and systolic pulses, relay means actuated by diastolic pulses, under control of said detector switch means, relay means actuated by systolic pulses under control of said detector switch means, one of said relay means being connected so as to be operable as aforesaid only if the other said relay means is operated, means for electrically locking each relay means separately in operated condition, upon actuation as aforesaid, and cyclically operable reset switch means actuated for a cycle of operation by one of said relay means for causing release of both relay means from electrically locked condition, and testing means actuated by said reset switch in certain cycles of operation thereof. u.

19. In a blood pressure machine, control means comprising, a diastolic relay, a systolic relay, a pulse-actuated switch, a reset switch, cam means for actuating said reset switch, electrically controlled release means normally restraining said cam means from rotation, motor means normally 20. In a blood pressure apparatus, control` means comprising: a diastolic circuit switch, a

systolic circuit switch, pulse sensitive means forA actuating said switches respectively in response to diastolic and systolic pulses in an artery in which the blood pressure is being ascertained, a ilrst circuit control means actuated by one of said switches, a second circuit control means actuated by the other said switch, a holding circuit set up for said first and second control means upon actuation as aforesaid, a holding circuit switch normally operable to maintain said holding circuit in operative condition when set up, cam means rotatable a certain amount from a starting position to operate said holding switch and open said holding circuit, motor meansy normally tending to rotate said cam means, releasable means normally restraining said cam means from rotation, and means actuated by at least one of said first or second circuit control means for ellecting release of said releasable means to free said cam for rotation a certain amount to actuate the holding switch means as aforesaid and thereafter arrest the cam means following rotation of the same the certain amount aforesaid, said cam means being adapted to actuate an instrumentality in said apparatus when released as aforesaid.

2l. In apparatus of the class descibed, in combination, a detector switch adapted to be actuated by diastolic and systolic arterial pulses, relay means controlled by said detector switch, a holding circuit set up by said relay means upon actuation of the detector switch as aforesaid, a cam reset switch operable in cycles to release said holding circuit once during each cycle of operation, electrical means actuated by said relay means to effect a cycle of operation of said cam reset switch to eect release of said holding circuit, as a result of each complete operation of the relay means responsive to systolic and attendant diastolic pulse operations of said detector switch, and control means actuated by said cam reset switch during each cycle of operation thereof.

22. Ina blood pressure machine means for applying and varying fluid pressure to detect arterial pulses at the diastolic and systolic levels, detector switch means actuated by diastolic and systolic pulse reactions detected as aforesaid, a timer switch, diastolic and systolic relays actuated by said detector switch means, a holding circuit set up by successive operation of said relays, reset switch means actuated as a result of the aforesaid successive operation of said relays to -break said holding circuit, and a stepping type switch advanced partly under control of said reset switch upon each circuit breaking action thereof as aforesaid, and partly under control of said timer switch dependent upon the number of successive advances made by said stepping switch in a given period of time, and means for maniresting the degree of pressure, applied as aforesaid following a certain number of advances oi' said stepping switch, together with means for automatically resetting said stepping switch if the same fails to take said given number of steps, and also following the taking of said number of steps.

23. In a blood pressure machine, a detector switch actuated by systolic and diastolic pulses, systolic and diastolic relays, a motor driven reset switch electrically releasable for operation in cycles, a timer switch, an electrically actuated commutator switch, and circuit connections whereby said relays are operated in succession by systolic and corresponding diastolic operations of said detector switch and are held operated by a locking circuit subsequently opened by said reset switch responsive to release of said releasable means under control of at least one of said relays when operated in said locking circuit, and connections for causing operation of said commutator switch means ,in an alternate manner under 'control of said reset switch and said timer switch dependently upon a predetermined order and number of operations of said relays, and circuit connections controlled by said commutator switch dependently up a. certain number of operations thereof under control of the reset and timer switch means aforesaid.

24. In a blood pressure machine, means for sensing arterial pulses, a relay actuated by said sensing means responsive to the sensing thereby of a pulse attending a systole, a relay actuated by said sensing means responsive to the sensing thereby of a pulse attending a diastole, a locking circuit closed by each said relay upon actuation as aforesaid, reset switch meanscontrolled by one of said relays for breaking the holding circuit for both relays, and a circuit commutating switch actuated in certain positions by said reset switch upon resetting operation thereof to break the holding circuit, whereby to establish a diil'erent operative circuit for the commutating switch, and a second means for actuating said commutating switch by said diiferent operating circuit, whereby to advance the commutating switch to a predetermined position and reestablish a control circuit therefor to said reset switch for further advance of the commutating switch, circuit connections instrumental in ascertainment of blood pressure by said machine being established by said further advance, and means for restoring said commutating switch to a starting position under control oi' said second actuating means therefor, provided the same is not advanced by said reset switch at certain times when it is come1 nected to operate the commutating switch as aforesaid.

25. In a blood pressure machine in combination, a commutator switch for setting up various control circuits employed in said machine, relay means controlled by arterial pulses, a holding circuit for said relay means and established by a predetermined operation of said relay means, an. intermittently operable reset switch releasable to open said holding circuit, means for advancing or resetting said commutator switch, an intermittently operable timer switch timed to operate at intervals between which a predetermined number of arterial pulses may occur, and circuit connections for the foregoing instrumentalities so arranged that said commutator will be advanced or reset under control of'said reset switch and said timer switch dependently up the nurnber, sequence, and timing of operations of said relay means by arterial pulses, as aforesaid, said commutator switch being connected to establish certain ot/said control circuits when advanced to certain portions as aforesaid.

26'. The combination dened in claim 25 and further characterized by the inclusion of pressure ascertaining and manifesting means, pulse s counting means, circuit connections, and relay means controlled by said commutator switch for cycling the operation of said machine and causing the latter to operate in three testing phases, during one of which the diastolic pressure is ascertained and manifested, and during a second of which the systolic pressure is ascertained and manifested, and during a third phase of which the number of pulses occurring in a given time period is counted and manifested as a rate measure, together with means for initiating cyclic operation of said machine.

27. In a blood pressure machine of the type adapted to apply pressure to an artery for testing purposes, an arm rest for applying said pressure and comprising a member having a trough portion shaped to receive the wrist with an ad- Joining raised portion having confor-mations adapted to receive and individually seat the iingers of the hand adjoining said wrist, pressure applying means in said trough for engagement with portions of said wrist, and strap means' for securing said wrist in position inthe trough for engagement with said pressure applying means.

28. A body-engaging device for testing pui'- poses of clinical nature, said device comprising a member having a mound-like portion with depressions arranged to receive the ngers of a hand in partially closed condition, said member having a portion adjoining said mound to receive the wrist, at least, of said hand, testing means in said wrist-receiving portion; and means for releasably holding a wrist member in said wristreceiving' portion.

29. A body-member rest for use in tests of clinical nature, said rest comprising an elevated member having congurations to receive separately the appendages of a hand, including the wrist portion thereof, expansible testing in the part of said device which receives said wrist, and means including a movable element and releasable lever mechanism cooperable therewith such that said movable element may be moved in one direction to confine a wrist member in said part receiving the same, but is automatically restrained against movement in an oD- posite direction responsive to effort of said wrist portion to move outwardly of said receivingpart as a result of expansion of said expansible means. said lever mechanism being operable to free said movable element for movement in said opposite direction to permit withdrawal of said wrist portion. 

